Management Of Avulsion Research Articles

Endovascular snare kit in the combined antegrade and retrograde management of ureteral avulsion: report of two cases

We report the feasible and safe use of the Amplatz Goose Neck Snare kit for avulsed ureter retrieval during ureteroscopy. A 49-year-old lady and a 61-year-old man complaining of urolithiasis underwent ureteroscopy; following stone fragmentation, and basketing avulsion of the ureter occurred. Using the Amplatz Goose Neck Snare kit it was possible to place an indwelling ureteral catheter in both cases aiming at restoring the urinary upper tract continuity. The snare-assisted endovascular technique may be an interesting tool even in endourology for the management of ureteral avulsion. This endoscopic mini-invasive procedure makes it possible to avoid an immediate invasive surgical approach often resulting in nephrectomy, having time for planning a possible durable conservative treatment.

Use of Free Peritoneal and Bladder Mucosal Grafts as Ureteral Mucosa Substitutes for Management of Avulsion of the Ureteral Mucosa in a Dog Model

Avulsion of the ureteral mucosa is one of the most serious complications of ureteroscopy and considered challenging for urologic surgeons. In this study, we developed two novel methods to reconstruct the impaired ureter. After ureteral mucosal avulsion in a canine model, ureteral reconstruction was performed in one of three ways: free tabularized peritoneal grafts (group A, n = 6); bladder mucosal grafts (group B, n = 6); or simple stenting technique (control group [n = 3]). At postoperative week 10, evaluation with intravenous urography (IVU) was followed by harvesting of reconstructed ureter segments for pathologic analysis. IVU showed nonvisualization of the collecting system of the affected side and histologic evaluation showed imperforation or stenosis in all animals in the control group. IVU showed good visualization of the reconstructed ureter without stenosis in group A and in most animals in group B. There was a mild dilation but no obvious stenosis in one animal in group B. Microscopically, all the reconstructed ureteral lumens were uniformly lined with transitional epithelium. Extensive neovascularity was evident in the subepithelial layer with a streaming of fibroblasts toward the neomucosa. Replacing the avulsed mucosa in the injured ureter with tubularized peritoneal free grafts or bladder mucosal grafts may be an optimal method to manage avulsion of the ureteral mucosa.

Total, nonreplantable scalp avulsion: utility of artificial dermis

Scalp avulsion is rare and generally occurs when long hair is caught in rotating devices. The main treatment issue is to restore lost tissue and hair follicles. Microsurgery has considerably facilitated the management of scalp avulsion, often allowing immediate coverage and normal hair growth. Reimplantation is clearly the best solution, and coverage can be a problem when reimplantation fails or is impossible. We describe the case of a 15-year-old teenage girl whose plait was caught in a go-kart engine and whose scalp was totally avulsed. The avulsed scalp was damaged by the engine, and detailed microsurgical examination showed that reimplantation was not feasible. Coverage was achieved by local epicranial plasty and by artificial dermis grafting once sufficient granulation tissue had formed. The avulsed surface was then covered with a thin skin graft. Total healing was obtained after 7 weeks. The regenerated skin is supple and stable over time and is easy to cover each day with a hairpiece. No ulceration has occurred after 2 years of follow-up.

Clinical management of avulsion

Clinical management of avulsion

Oral trauma and dental emergency management recommendations of first‐aid textbooks and manuals

The recommendations of oral trauma and dental emergencies management of nine first-aid textbooks and manuals from the last two decades were evaluated. Only one book includes all the relevant topics: dental anatomy, management of tooth luxations and avulsion, tooth fracture, mandible dislocation, jaw fracture, intraoral bleeding and dental pain. Two books recommend self-replantation of an avulsed tooth, but four books detail the storage media and evaluate the importance of a quick referral to a dental surgery. In three first-aid books, the only mention of oral trauma is the hazard of choking from tooth fragments, and in one other book, only mandible dislocation is mentioned as oral trauma. The insufficient information of oral trauma management in these first-aid texts partly explains the previous reports of poor and inadequate knowledge in that topic among medics, teachers and the general public.

Analysis of procedures used in tooth avulsion by 100 dental surgeons

Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion, because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth. The aim of this study was to analyze the procedures used in the management of tooth avulsion by 100 dental surgeons (DSs). Thus, by means of a descriptive questionnaire, information was obtained about the profile of the professionals interviewed, procedures used in cases of tooth avulsion, and patient orientation and education. One hundred properly filled questionnaires were obtained. Descriptive statistics was used for the data, and the chi-squared statistics was employed (epi-info 3.2 software). According to the results, this type of trauma is part of the routine of 15 DSs, although 71 have reported some experience with avulsed teeth. Great deficiencies were found regarding root surface treatment and occlusal adjustment. Positive findings were related to socket treatment, adjunctive therapy, and patient education and orientation (extra-alveolar period, storage medium, manipulation of the avulsed tooth, replantation by the own patient). It was possible to conclude that 47.5% of the procedures reported by 100 professionals interviewed are adequate, and patient education is favorable in 87.7% of cases, a fact that can positively interfere with the prognosis of tooth replantation.

Knowledge of general practitioners dentists about the emergency management of dental avulsion in Curitiba, Brazil

The prognosis of traumatized teeth in general and of avulsed teeth in particular depends on prompt and appropriate treatment. Management of traumatic injuries may be a challenge to the non-specialized dentist, as they may occur when dentists are least prepared for it. The objective of this research was to investigate the knowledge of general practitioner dentists about the emergency management of dental avulsion in Curitiba, PR, Brazil. A group of 250 professionals were interviewed. The questions were related to knowledge of how to treat traumatic avulsion of teeth. The results suggest that the level of knowledge on the management of dental avulsion of the general practitioners dentists in Curitiba is adequate.

Evaluation of the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil

Tooth avulsion is common in children, and emergency management in these cases is critical. This management can be made, not only by a dentist but by people who are present where the accident occurs. Consequently, knowledge of tooth avulsion is fundamental for school professionals working with children. The purpose of the present study was to evaluate the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil. For that purpose a questionnaire, including questions regarding emergency procedures for tooth avulsion, was answered by 117 teachers. The results demonstrated that 75.2% of school professionals knew the importance of emergency management and 60.6% would look for a dentist for treatment of the cases; 18.8% would reimplant the tooth and 7.6% would keep it in milk. This study showed the lack of knowledge of teachers on tooth avulsion; educational campaigns are necessary to improve the emergency management of tooth avulsion.

Knowledge of Jordanian mothers with regards to emergency management of dental trauma

Studies in Jordan indicated that delay in seeking emergency management of dental trauma leads to unfavorable outcome of even mild forms of trauma. The purpose of this cross-sectional study was to assess, by means of a structured questionnaire, the level of general knowledge of mothers in Jordan with regards to the immediate emergency management of dental trauma, and its relation to socioeconomic variables. The questionnaire surveyed mothers' demographic data, basic knowledge of immediate management of tooth fracture, avulsion, and loss of consciousness. It also investigated the participants self assessed knowledge, attitude to public education, and knowledge of availability and priority of emergency services for trauma in Jordan. The sample consisted of 2215 mothers who attended mother and child care centers in the capital Amman, and in Irbid (the second largest city in Jordan) over a period of 3 months (July to September, 2003). Overall the participants' basic knowledge with regards to the emergency management of the trauma cases presented in the questionnaire was deficient regardless of age, level of education, socioeconomic class, or number of previous encounters with dental trauma. Generally, the attitude to public education on the topic was positive and chi-square test indicated that the level of education of mothers positively affected their knowledge of 'during working hour' emergency services and the importance of immediate management of dental trauma. Educational programs that can be added to the mother and child care advice protocols may help improve the knowledge and awareness of mothers and therefore improve the outcomes of dental trauma.

Physical education undergraduates and dental trauma knowledge

The aim of the present study was to assess the level of knowledge of undergraduates from the College of Physical Education (Toledo, Araçatuba) concerning dental avulsion injuries. Data showed that 95% of the respondents did not know what dental avulsion is, 73.5% said they know how to define dental replantation, however, only 26% were able to do it correctly. When asked about first emergency measures after an avulsion, 50% of the respondents said they know what they should do, and the most cited measure was to seek a dentist. When asked about optimal storage media, 45.5% would keep it in a favorable one, and 28% did not know where to keep the tooth until treatment. Only 25.6% indicated a suitable extra-oral time for replantation; 90.3% of the respondents had received no advice about the emergency management of dental avulsion; 90% said they consider this an important and necessary subject. The results indicated that educational campaigns are necessary to improve the emergency management of dental injuries by those future P.E. professors for a better prognosis of dental replantation.

Knowledge and attitude of Jordanian school health teachers with regards to emergency management of dental trauma

The purpose of this study was to assess, by means of a self administered structured questionnaire, the level of knowledge of school health teachers in northern Jordan with regards to the immediate emergency management of dental trauma. The questionnaire surveyed teacher's background, Knowledge of management of tooth fracture, avulsion, and loss of consciousness, it also investigated teacher's attitudes, and self assessed knowledge, as well as knowledge of availability of emergency services in Jordan. The sample consisted of all school health teachers in northern Jordan (220) who attended an oral health education course held by the Jordanian dental association. Only 190 were included in the survey. Sixty-three percent were females, 44% were in their twenties, and 43% in their forties. Their school health teaching experience ranged from 1 to 7 years. Only 20% were officially trained in school health. Less than half of the teachers received first aid training only once in their teaching career, not necessarily as part of school health training. Only 10 teachers were trained in dental first aid, and more than half had a previous experience with handling dental trauma in children. Overall the teachers' knowledge with regards to the emergency management of the trauma cases presented in the report was deficient. Chi-square test showed that, the difference in their responses to the knowledge part of the questionnaire was not statistically significant with regards to age, gender, years of teaching experience, first aid training, or number of seen trauma cases. Generally, the attitude was positive, most teachers wanting further education on the topic, however those who were trained in first aid, thought they were able to give proper action when needed in cases of trauma (P = 0.026). Most teachers were unsatisfied with their level of knowledge, and only 30% knew of the availability of after hour emergency services for dental trauma. The present report indicated the gross lack of knowledge among school health teachers with regards to dental trauma emergency management. Educational programs to improve the knowledge and awareness of this group of adults, who are usually the first line of advice in case of dental trauma in schools, are mandatory. These programs should be properly designed to insure that proper information is retained with a positive effect on attitude, and self assessed competence.

Avulsed permanent incisors: knowledge and attitudes of primary school teachers with regard to emergency management.

This study was designed to examine the knowledge and attitudes of primary school teachers with regard to the emergency management of avulsed permanent incisors. Data were collected by self-administered questionnaire. The study was conducted in primary schools lying within a 2-mile radius of the University Dental Hospital, Cardiff. Sample and methods. A total of 388 teachers in 31 participating schools were asked to complete a questionnaire, which was subsequently collected by two of the authors (CS and AT). Two hundred and seventy-four teachers returned completed questionnaires, a response rate of 70.6%. One hundred and eighty-one respondents (60.1%) had received no advice about the emergency management of dental avulsion. Of the 133 teachers (48.5%) who possessed a first aid certificate, 39 (29.3%) had been given relevant advice as part of this training. Less than one-third of respondents (85 (31%)) cited an optimum extra-oral time of 30 min or less, with only 43 (15.7%) considering that this should be 10 min or less. However, 125 (45.6%) knew milk to be the best transport medium. Two hundred and four teachers (74.5%) stated that they would not be prepared to replant an avulsed tooth themselves, 133 (80%) basing this decision on lack of expertise and training. Two hundred and sixty-two teachers (95.6%) expressed a desire for further information. The majority of respondents possessed, at best, rudimentary knowledge of the emergency management of dental avulsion. Teachers, and other individuals who supervise children in schools, should receive simple instruction in dental first aid.

Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong.

The purpose of this study was to investigate the knowledge of a group of physical education (PE) teachers about the emergency management of dental trauma in Hong Kong. A postal questionnaire was sent to PE teachers in 100 randomly selected secondary schools in Hong Kong. A total of 166 teachers from 65 schools responded. Results show that a majority of the respondents have received formal teaching training (98.8%). While all but one teacher had received formal first aid training, only eight of them recalled that they had received advice on the management of dental trauma. Concerning the management of tooth fracture, 118 respondents (71.1%) gave an appropriate answer. In contrast, only 29 teachers (17.5%) were able to indicate the appropriate management for an avulsed tooth. Over 60% (102) of the respondents indicated it was "very urgent" to seek professional assistance if a permanent tooth has been avulsed, but they had little knowledge of the correct procedures for replanting or transporting avulsed teeth. Only 15 respondents (9%) pointed out that milk was the medium of choice for transporting avulsed teeth. Finally, over 90% (157) of respondents indicated that they had never received advice on the emergency procedures for the management of dental avulsion. The present study showed that the level of lay knowledge of management of dental injuries in a selection of PE teachers in Hong Kong is inadequate and educational campaigns are necessary to improve their emergency management of dental injuries.

Avulsion of the Triceps Tendon

Avulsion of the triceps tendon should be suspected in patients who have pain about the elbow following a deceleration stress to the upper extremity. In three cases, the avulsion occurred both with or without a concomitant blow to the posterior aspect of the arm. Examination revealed pain, swelling, and a palpable depression just proximal to the olecranon. Roentgenograms showed avulsed osseous material. In the evaluation and management of triceps avulsion, it was important to differentiate between complete and partial tears. Careful examination of active range of motion of the elbow was the most important factor in making this determination. An avulsion was considered partial only if normal elbow motion and extension against resistance were found on follow-up examination a few days postinjury. Nonoperative management was successful in one case of partial tear (Case 2). Surgical therapy was advisable for complete avulsions. Surgical repair was successful using heavy nonabsorbable suture through olecranon drill holes. Injuries of tendon avulsion and rupture are likely to become more common as the number of patients with chronic renal failure, on dialysis, increases. Tendo-osseous weakness and related musculoskeletal disorders in renal osteodystrophy patients are unsolved problems.

Management of Avulsion and Articular Fractures

Management of Avulsion and Articular Fractures

Parental awareness of emergency management of avulsion of permanent teeth of children in Lagos, Nigeria

Traumatic injuries in children and adolescents affecting both the primary and permanent dentitions and their supporting structures are a common problem seen in children. Avulsion of permanent teeth in children resulting from trauma is an emergency in children. The prognosis of avulsed teeth depends on prompt and appropriate treatment, which often relies on lay people such as the children's parents and their schoolteachers who are present at the site of the accident, prior to the initial professional dental contact. Knowledge of parents on the emergency management is thus surveyed. A 13- stemmed questionnaire comprising questions on demographic data, attitude and knowledge was distributed to parents who have accompanied their children (patients) to the Orthodontic/Paedodontic Clinics of Lagos University Teaching Hospital (LUTH) for treatment over a 12-week period from October- December 2002. A total of ninety parents were studied. Over 90% of the parents felt they should seek professional help urgently following an avulsion injury, but their knowledge of transport medium for the tooth was poor. Only 1.1 per cent and 3.3 per cent knew that milk was the medium of choice for washing and transporting an avulsed tooth respectively. 91.1% of parents surveyed had never received advice on what to do in the event of an accident where a permanent tooth was avulsed. There is a need for educational campaigns aimed at parents to increase their knowledge of the emergency procedures required when the tooth is avulsed.